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Block 4 > Lower Limb: Proximal Neurovasculature > Flashcards

Lower Limb: Proximal Neurovasculature Flashcards

1
Q

What are the motor functions of the sciatic nerve?

A

Tibial portion:

  • Posterior compartment of thigh excl. short head of biceps femoris
  • Hamstring component of adductor magnus
  • All muscles in posterior compartment of leg and sole of foot

Common fibular portion:

  • Short head of biceps femoris
  • All muscles in anterior and lateral compartments of the leg
  • Extensor digitorum brevis.
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2
Q

What are the sensory functions of the sciatic nerve?

A

Tibial portion:

  • Skin on posterolateral and anterolateral leg
  • Sole of foot

Common fibular portion:

  • Lateral leg
  • Dorsal aspect of foot
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3
Q

What does the pudendal nerve innervate?

What are its nerve roots?

A

S2-S4

Motor:

  • Skeletal muscles of perineum
  • External urethral sphincter
  • External anal sphincter
  • Levator ani.

Sensory:

  • ​Penis
  • Clitoris
  • Skin of perineum
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4
Q

What nerves are produced from the lumbar plexus?

What are their nerve roots?

A

Subcostal nerve: T12

Iliohypogastric nerve: L1

Ilioinguinal nerve: L1

Lateral cutaneous nerve of the thigh: L2, L3

Femoral nerve: L2,3,4

Genitofemoral nerve: L1, 2

Obturator nerve: L2,3,4

Lumbosacral trunk: L4,5

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5
Q

Describe the course of the lateral cutaneous nerve of the thigh

What does it innervate?

What are its nerve roots?

Where can it be compressed?

What are the symptoms of this?

A
  • L2-L3
  • Emerges superficial to the sartorius muscle under the inguinal ligament.
  • Enters enterior thigh close to ASIS where it can be compressed (often by underwear, belts etc) = meralgia paraesthetica
  • Innervates anterior and lateral skin of thigh

Symptoms:

  • Paraesthesia to anterior lateral thigh
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6
Q

What passes through the femoral triangle?

A

Lateral to medial:

  • Femoral Nerve
  • Femoral Artery
  • Femoral Vein
  • Lymphatics

(NAVL)

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7
Q

What are the borders of the femoral triangle?

A

Superior: Inguinal ligament (ASIS to pubic tubercle)

Lateral: Sartorius muscle

Medial: Adductor longus muscle

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8
Q

How is the femoral artery located in the femoral triangle?

A

Femoral artery enters at mid inguinal point (halfway between pubic symphysis and ASIS) +/- 1cm

Femoral vein sits roughly 1cm medial

Nerve sits roughly 1cm lateral

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9
Q

What is the adductor canal?

What are its borders?

What does it contain?

A

Canal extending from the apex of the femoral triangle to the adductor hiatus of the adductor magnus. Runs deep to sartorius.

Borders:

  • Anterior: sartorius
  • Lateral: vastus medius
  • Posterior: adductor longus and adductor magnus

Contains:

  • Superficial femoral artery
  • Femoral vein
  • Saphenous nerve
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10
Q

Describe the blood supply to the lower limb

A
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11
Q

What could be at risk in a pelvic ring fracture?

A

Laceration of iliac arteries

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12
Q

What artery is the main blood supply to the lower limb?

How does it travel down the lower limb?

A

Femoral artery

  • Enters femoral triangle at 1.5cm medial or lateral the mid inguinal point
  • Exits at the adductor canal at the apex of the femoral triangle
  • Passes through the adductor hiatus to the popliteal fossa where it becomes the popliteal artery.
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13
Q

What can anterior compartment syndrome cause?

A

Occlusion of the femoral artery causing no distal arterial supply to the lower limb- ischaemia

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14
Q

Describe the inguinal lymph nodes

What do they drain?

A

Superficial inguinal lymph nodes:

  • Horizontal group sit below inguinal ligament
  • Vertical group follow proximal part of great saphenous vein

Deep inguinal lymph nodes:

  • Located in femoral canal (Cloquet’s nodes) and medial to femoral vein

Drain:

  • Lower limb
  • Perineal region
  • Penis
  • Lower anal canal
  • Lower vagina
  • Anterior labia majora/ scrotal skin
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15
Q

What can the great saphenous vein cause in the femoral triangle as it runs to meet the femoral vein?

A

Saphena varix

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16
Q

Label the parts of the tibia and fibula on the diagram

A
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17
Q

Label the compartments of the leg, bones and neurovasculature on the diagram

A
18
Q

What gait could patients adopt if they have damage to the anterior compartment of their leg?

A

Damage to anterior compartment = foot drop

Circumduction gait

High stepping gait with toe landing

19
Q

What is the arterial supply of the anterior compartment of the leg?

A

Anterior tibial artery

20
Q

What is the arterial supply to the lateral compartment of the leg?

A

Fibular artery

21
Q

What is the arterial supply to the posterior compartment of the leg?

A

Posterior tibial artery

22
Q

What type of joint is the knee?

What movements is it capable of?

A

Modified synovial hinge joint

  • Flexion
  • Extension
  • Rotation (medial and lateral)
23
Q

Where is the knee joint line palpable?

A

Palpable posteriorly

(Sits approx 2cm distal to the skin crease)

24
Q

Which 3 bones form the knee joint?

What are the articulations?

A

Patella

Femoral condyles: medial and lateral

Articulations:

  • x2 femero-tibial
  • x1 femero-patellar
25
Q

Label the parts of the knee joint on the specimens

A
26
Q

What is the knee joint supported by?

A

Muscles

Ligaments

Menisci

27
Q

What are knee menisci?

What are their roles?

How can they be damaged?

A

Crescent shaped peices of fibrocartilage which sit on the tibial condyles

  • Increase articular surface of the knee joint
  • Spread force across knee joint
  • Weight bearing
  • Shock absorption
  • Participate in locking mechanism

Can be damaged by:

  • Compression
  • Medial and lateral collateral ligament tears
28
Q

Label the ligaments on the diagram

A
29
Q

What are the roles of the patella?

What are its articulation points?

A

Articulates with the femoral condyles

Reduces ligament wear and tear

Spreads forces passing to femoral condyles

Increases the mechanical bending force (moment) of the quadriceps muscles

30
Q

What has occurred in the two x-rays?

A

Left:

  • Excessive force from the quadriceps tendon has caused an avulsion fracture of the patella

Right:

  • Rupture of the patellar tendon (patient is a child, what looks like an avulsion fracture is the growth plate)
  • Patella has been displaced by unopposed quadriceps tendon force.
31
Q

What is the role of the cruciate ligaments?

How are they named?

Label them on the diagram

A

Resist anterior-posterior translocation and rotation of the knee:

  • Posterior cruciate ligament prevents posterior tibial movement on the femur
  • Anterior cruciate ligament prevents anterior tibial movement on the femur

Named according to their position of attachment to the tibia

32
Q

Which examinations are used to test for anterior cruciate ligament damage?

Which is the most sensitive for anterior cruciate ligament damage? Why?

A

Anterior draw test (90°)

Lachman test (20°)- more sensitive for anterior cruciate ligament damage (reduces false negatives associated with hamstring tension)

33
Q

What is the role of the medial and lateral collateral ligaments?

What can damage each one?

Label them on the diagram

A

Resists valgus and varus forces on the knee

Lateral collateral ligament:

  • Prevents tibial adduction (varus movement)
  • Damaged by excess medial force on the knee (varus stress)

Medial collateral ligament:

  • Prevents tibial abduction (valgus movement)
  • Damaged by excess lateral force on the knee (valgus stress)
34
Q

How can the knee bursae become inflamed?

Label them on the diagram

A
35
Q

Where is the suprapatellar bursa?

What test can be done to assess for excess fluid in this bursa?

A

Patellar tap:

  • ‘Milk’ suprapatellar bursa inferiorly then press patella anteriorly
  • Tap sensation is felt if excess fluid (effusion) present
36
Q

What is close packing of the knee?

Which muscle ‘unlocks’ this knee position?

A

At the end of extension, femur rotates slightly medially on tibia and ‘locks’ into position

  • Passive movement
  • Ligaments are placed under tension
  • Position of stability

‘Unlocked’ by popliteus muscle via lateral rotation

37
Q

What muscles are in the posterior compartment of the leg?

What is their innervation?

What are their actions?

What are their attachment points?

A

ALL innervated by tibial nerve (different nerve roots)

  • Foot and digit plantarflexion
  • Foot invertors

Superficial:

  • Soleus
    • Tibial nerve S1-S2
    • Attaches to calcaneus via calcaneal tendon
  • Gastrocnemius
    • Tibial nerve S1-S2
    • Attaches to calcaneus via calcaneal tendon

Deep:

  • Flexor hallucis longus
    • Tibial nerve S1-S2
    • Attaches to distal phalanx of digit 1
  • Flexor digitorum longus
    • Tibial nerve S1-S2
    • Attaches to distal phalanges of digits 2-5
  • Tibialis posterior
    • Tibial nerve L4-L5
38
Q

What muscles are in the anterior compartment of the leg?

What innervates them?

What are their actions?

What could occur as a result of damage/deinnervation?

A

Tibialis anterior

  • Dorsiflexion of foot and foot inversion
  • Dynamic support of medial arch
  • Deep fibular nerve (L4, L5)
  • Damage= foot drop (loss of L4)

Extensor digitorum longus

  • Dorsiflexion of foot and extension of digits 2-5
  • Deep fibular nerve (L5)

Extensor hallucis longus

  • Dorsiflexion of foot and extension of digit 1 (great toe)
39
Q

Where is the common fibula nerve vulnerable to damage?

A

At the head of the fibula where it is subcutaneous

At risk from damage/compression

40
Q

What muscles are in the lateral compartment of the leg?

What innervates them?

What are their actions?

Where do they attach to?

What could they potentially damage?

A

Fibularis longus​

  • Foot eversion and plantar flexion
  • Resists excess inversion
  • Supports arches of foot
  • Superficial fibular nerve (L5-S2)

Fibularis brevis

  • Foot eversion, resists excess inversion
  • Superficial fibular nerve (L5-S2)
  • Attaches to tuberosity of 5th metatarsal, can cause avulsion fracture following excess inversion
41
Q

What reflex can be tested by tapping the calcaneal tendon?

A

S1-S2

42
Q

What does the popliteal fossa contain?

What are its 4 borders?

Label them on the diagram

What can damage the structures within the popliteal fossa?

A
  1. Semimembranosus & semitendinosus
  2. Biceps femoris
  3. Medial head of gastrocnemius
  4. Lateral head of gastrocnemius

Popliteal artery

Popliteal vein

Tibial nerve (middle)

Common fibula nerve (under biceps femoris)

Can be damaged by supracondylar fractures

Block 4 (20 decks)

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